MASSAGE. -: f 



portion of the hands when all the rest might be occupied. 3. The 

 patient should be placed in as easy and comfortable a position as pos- 

 sible, in a well- ventilated room at a temperature of about 70" Fahr. 

 4. What constitutes the dose of massage is to be determined by the 

 force and frequency of the manipulations and the length of time 

 during which they are employed. A good manipulator will do more 

 in fifteen minutes than a poor one will in an hour, just as an old ma- 

 chanic working deliberately will accomplish more than an inexperi- 

 enced one working furiously. Friction has been described as recti- 

 linear, vertical, transverse or horizontal, and circular. It has been 

 stated, and very properly, that rectilinear friction should always be 

 used in an upward direction, from the extremities to the trunk, so 

 to favor and not retard the venous and lymphatic currents. But a 

 slight deviation from this method I have found to be more advanta- 

 geoQs, for though in almost every case the upward strokes of the friction 

 should be the stronger, vet the returning or downward movement mav 

 with benefit lightly graze the surface, imparting a soothing influence, 

 without being so vigorous as to retard the circulation, and thus a 

 saving of time and effort will be gained. The manner in which a 

 carpenter uses his plane represents this forward-and-return movement 

 verv well. Transverse friction, or friction at right angles to the long 

 axis of a limb, is a very ungraceful and awkward procedure. It has 

 been introduced on theoretical considerations alone, and mav with 

 safety be laid aside, for the method already spoken of, together with 

 circular friction, will do all and a great deal more than rubbing cross- 

 wise on a limb can do. A convenient extent of territory, to begin 

 with, is from the ends of the fingers to the wrist, each stroke being 

 of this length, the returning stroke being light, without raising the 

 hand. The rapidity of these double strokes may be from one hundred 

 to one hundred and fifty a minute. The whole palmar surface of the 

 fingers should be employed, and in such a manner that they will fit 

 into the depressions formed by the approximation of the phalang 

 and metacarpal bones. The heel of the hand should be used for 

 especially vigorous friction of the palm, as well as for the sole of the 

 foot. From the wrist to the elbow, and from the elbow to the shoul- 

 der, are separately convenient extents of surface, and here not only 

 -:raight-line friction, extending from one joint to the other, may be 

 used, but also circular friction. The form of the latter which I have 

 found most serviceable is in that of an oval, both hands moving at 

 the same time, the one ascending as the other descends, at the rate of 

 one hundred and twenty-five to two hundred and fifty each a minute, 

 or two hundred and fiftv to five hundred with both hands, each stroke 

 reaching from joint to joint, the upward stroke being carefully kept 

 within the limits of chafing the skin. These observations apply to 

 the lower limbs also, but, as they are larger than tm? arms, the pos- 

 terior and lateral aspects, from ankle to knee, will be a convenient 



